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Defense Health Care: Tri-Service Strategy Needed to Justify Medical Resources for Readiness and Peacetime Care


Published September 1999
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The Department of Defense’s (DOD) military health system (MHS), costing
about $16 billion annually, offers care to 8.2 million military and civilian
beneficiaries. The system has a dual role of medically supporting wartime
deployments—its readiness mission—while caring for active duty
members, retirees, and their families in peacetime. The Army, Navy, and
Air Force provide most of the system’s care through their own medical
centers, hospitals, and clinics, totaling about 580 treatment facilities
worldwide. Regional networks of civilian providers supply the remaining
care. MHS has undergone major demographic changes and, today, serves
more retirees than active duty beneficiaries and their respective families.
Also, mirroring overall military end-strength decreases during this decade,
military treatment facilities (MTF) have been closed or downsized, their
budgets constrained, and medical practices shifted toward an emphasis on
managed care. Such conditions have focused attention on the prospective
need for MTFs, the coordination of peacetime care among them, and
alternative care delivery approaches.

Among the areas affected by the changes is the national capital area (NCA),
in and around Washington, D.C. There, the three services offer care to
about 400,000 beneficiaries in 26 MTFs, including 3 medical centers.
Concerned about potential service overlaps and whether increased
efficiencies are possible, the Congress, in the 1998 Defense Authorization
Act mandated that we review the need for and coordination of care among
NCA MTFs. This review is the second of two GAO reviews mandated by the
act. In the first review, we examined the Navy’s and Army’s attempts in
1997 to downsize and close certain graduate medical education
programs—the primary source of military physicians. In the resulting
April 1998 report, we found that DOD and the two services lacked mutually
acceptable criteria and methods for targeting the graduate medical
education programs. DOD agreed with our recommendation to develop the
needed guidance and is now doing so.

As agreed with your offices, this review’s objectives are to (1) evaluate the
need for NCA MTFs and DOD’s strategy for assessing such needs, (2) identify any obstacles hindering DOD’s ability to make coherent needs assessments, and (3) determine whether current care coordination among NCA MTFs could be improved. We also agreed that, because NCA MTFs are integral parts of the overall MHS, we would assess recent DOD initiatives to make MHS management improvements. We conducted our work between
March 1998 and September 1999 in accordance with generally accepted
government auditing standards. For details on our methodology, see
appendix I.


Language English
Collection usnavybumedhistoryoffice; medicalheritagelibrary


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